*Purpose: We report the first case of bilateral renal autotransplantation after staged resection of a giant liposarcoma of the retroperitoneum.

*Methods: A 39-year-old male presented with vague abdominal pain. CT scan of the abdomen and pelvis showed a large, bilateral retroperitoneal liposarcoma encasing both kidneys. He underwent two staged surgeries in which first the left and then the right side of the tumor was resected. Each resection included an en-bloc nephrectomy with back-table dissection of the kidney from the tumor. The renal capsule was resected completely and the ureter stripped of periureteric fat before ipsilateral, intraperitoneal, pelvic renal auto-transplantation. The second stage was delayed 7 weeks after first operation.

*Results: The pathology of the tumor was significant for a grade 1 stage 1b T4N0 well-differentiated liposarcoma. Post operatively he was started on stress dose steroids that were subsequently tapered to maintenance dose. On POD 5 he was started on 0.1mg daily fludrocortisone. Hospital stay was 8 days after first stage and 14 days after second stage. He was discharged on 15mg hydrocortisone in the morning and 10mg in the afternoon as well as 0.1mg fludrocortisone daily. Normal renal function was maintained all through the course. At one and a half years of follow up there remains no evidence of recurrence of his tumor based upon surveillance CT scan imaging.

*Conclusions: Ex vivo resection and reimplantation of the kidney has three theoretical benefits. The first, is that it provides an improved ability to clear tumor around the kidney potentially with less blood loss. The second is that kidney auto-transplantion moves the kidney from the retroperitoneal location, where many retroperitoneal sarcomas are likely to recur, preventing recurrences from impacting the kidney and potentially making subsequent repeat resections easier if or when needed. Thirdly, moving the kidney to the intraabdominal pelvis would allow easier and potentially safer application of ablative therapies such as radiation and radiofrequency ablation to the region of the retroperitoneum should recurrence not managed with repeat resection occur.

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